Ethan C.A. Lee Dental INC.
Dentist in San Gabriel, CA. Organization (NPI-2).
NPI number1477044345
StatusActive
Last updated in NPPESMay 25, 2018
Details
- NPI
- 1477044345
- Entity type
- Organization (NPI-2)
- Legal business name
- Ethan C.A. Lee Dental INC.
- Organization subpart
- No
- Enumeration date
- May 25, 2018
- Last updated
- May 25, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 48688 | CA | Yes |
| 1223G0001X | Dentist, General Practice | 48595 | CA |
Practice location
314 W. Valley BlvdSan Gabriel, CA 91776
Phone 626-458-3410 · Fax 626-458-3411
Mailing address
314 W. Valley BlvdSan Gabriel, CA 91776
Phone 626-458-3410 · Fax 626-458-3411
Authorized official
Ethan C.A. Lee
DDS
6264583410
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